Mental Health Training

High Functioning: An unhelpful card to be holding, By Jane McNeice

Posted by on 23 May, 2017 in Mental Health |

High Functioning: An unhelpful card to be holding, By Jane McNeice

When many people think of mental health, they in fact think of mental illness, not the fact that we all have mental health as we have physical health, and the parity that should exist between both.

Mental health is often measured in ways that attempt to be as objective as possible (and rightly so) with much focus on mental illness, or in fact inability – what can or can’t you do today, the past week, month? Scales of 1-10 on whether you felt able to get up and go to work, whether you felt able to interact with family and friends, whether you could take care of your responsibilities. But for the so called ‘high functioning’ this doesn’t seem to equate. In fact we may supersede the average man on ability to perform or function, including the mentally healthy man! Because of traits like perfectionism, drive, our underlying fears, the desire to bury any appearance of anxiety and fear, and other often negative reinforcers, the measures just don’t pick up on what’s really happening…

So what is really happening under my high functioning, high achieving, high performing, results driven, perfect exterior? Inside my head no one is distinguishing between whether I ‘high function’ or not, my mind just knows the fears, the drive, the anxiety. The anxiety that has all the hallmarks as we might know them – waking me up when it’s still dark and my body is craving sleep, but my head wants to work out how I’m going to make sure all those tasks get done, so that I can assuage the fear and anguish of if they don’t – which of course they will because I’m HF! When I push myself right out of my comfort zone, for all the reasons previously stated (and more), because I’m always trying so hard to beat my monster that’s been chained to my side since the age of 3, the monster that I allow to censor what I say in an attempt not to offend, upset, and hurt anyone else but at the risk of hurting me. Maybe if the measures asked me about all the tactics I use to manage and assuage my intense ‘going to be eaten alive’ fear, they may capture something of how I feel inside. How many times a week do I ignore a phone call, search engine the number, and check who it might be so that I can mentally prepare to deal with it on my terms so that it’s manageable and I can cope? How many times did I do something I didn’t want to do to ensure someone else was alright, not in fear, upset, offended or sad? How many tasks did I complete this week that I still felt weren’t perfect or just quite good enough? And furthermore, on a scale of 1-10 just how anxious or sad did this make me feel? The true sadness is that oftentimes the highly anxious don’t leave a task like that till we have assuaged the fear, and have made it what we consider ‘perfect’, because the pain of it not being so is greater. The true hardship is exhaustion – high functioning anxiety makes me a machine of performance, with no real acknowledgement to the human inside. The human inside is sometimes lost, both to the high functioning self, and to others. The highly functioning ‘function’, so no one really questions our mental health? Ok, perhaps the more mental health astute sees the cracks, the window into the anxiety inside. But ‘high function’ is ‘hiding fear’ so that others don’t see it, and everything is ticking over so well from the exterior that no one needs to question it. In fact, it is often the case that many people benefit from being around the high functioning anxious e.g. work colleagues, family, and others. They can make other people’s lives much easier. Who’s to challenge that? So there’s much less motivation to question how someone may feel inside. They don’t appear to be ill, they don’t appear to be a suicide risk, and they’re ok.

Which makes ‘high functioning’ a very dangerous card to hold – no one sees the exhausted mind, and accompanying exhausted body. No one sees the lack of sleep. No one sees the hidden panic attack, which my mind and body went to immense lengths to conceal, despite such difficulties breathing. No one knows the fight to keep going, and most of all to challenge the monster that resides beside me. So I’m sharing this to highlight that mental health comes in all shapes and sizes. Yes, it’s the person that is feeling numb, it’s the person that maybe can’t get out of bed at the moment, or who doesn’t feel able to go to work and face other people, but it’s also me. It’s the person that, by all visual appearances – and to the untrained eye – is in work, successful, maybe managing a team of people or other high demands, who’s life, home life and relationships appear to be in perfectly good order, who doesn’t look unkempt, and who can support others well. Maybe it’s the perfectionist you work with, maybe the person that is always busy, or the person that constantly derives high results.

Mental health awareness requires minds to be open to the variety of presentations that are anxiety and other mental health conditions, so that the ‘high functioning’ don’t get missed, so that they or others can recognise when they are not well, recognise that their anxiety has a value too, and receive help when it is needed. It is essential that they don’t fall through the support net that is friends, family, and services. I recognised my High Functioning Anxiety immediately through reading about another person’s experience of it. I had spent a lifetime questioning how I felt constantly anxious but was able to hold down demanding jobs, high achieve, and meet all my actual responsibilities, plus everything else I imposed in my own head. Why I’d felt like a fraud, and endlessly questioned my judgement of whether I really was anxious, particularly at the times when I sought professional help. I had questioned it because, through my previous experiences and learning I too had been conditioned to think that everyone with anxiety presented in a certain way, which often focused on things they weren’t able to do as a result of their anxiety. The enlightenment on reading ‘What it’s like to have ‘High Functioning’ Anxiety’ by Sarah Schuster was immense – my lifetime puzzle finally piecing together – and the writer will never know just how grateful I was to finally understand myself and that I wasn’t a fraud, my mental ill health had been legitimised. Why did it take so long for this to happen?

There’s a wealth of information out there, books, journals, and all that is available on-line about anxiety and mental health, but you have to dig a little deeper to find information specifically on ‘High Functioning Anxiety’. High functioning seems to be something more often associated with autistic spectrum disorders  than with anxiety disorders. Perhaps this is because, by enlarge, we don’t consider those who are mentally ill to be able to function well. So without contrary information, people just aren’t aware of it, and that includes those with good or high awareness and understanding of mental health, and I include myself in this. Clinical professionals see many people in their work who are unwell, and who don’t feel able to function to their usual ability, so are some clinicians deluded to expecting and looking primarily for low function much more than high function? These are possibly some of the many reasons why it’s so important that people share their personal experiences of mental health and illness, because one size doesn’t fit all, and everyone’s experience is unique.